Treatment of Longstanding Alopecia Areata Universalis of the Eyebrows/Facial Hair with Oral and Topical Tofacitinib

The document discusses the treatment of alopecia universalis (AU), a severe form of alopecia areata (AA), with oral and topical tofacitinib. AU has no evidence-based treatments and tends to relapse frequently. However, targeting the JAK pathway in AA has shown to reverse the condition in animals and humans. Tofacitinib, approved for rheumatoid arthritis treatment, has demonstrated clinical efficacy in AU patients with minimal or no adverse events. Topical tofacitinib has shown some efficacy in AA, but not as much as its oral counterpart. The duration of hair loss, specifically the time since the hair follicles last grew hair, has been documented as a predictor of tofacitinib efficacy in AU. After 10 years of complete scalp hair loss, response to treatment decreases significantly, although some case reports have suggested patients respond well regardless of disease duration. The document includes a case study of a 38-year-old man with a 10-year history of AU.